超滤在10公斤以下小儿体外循环中的应用

Ultrafiltration Used in Cardiopulmonary Bypass of Children Less than 10kg

目的 总结婴幼儿先天性心脏病 (CHD)患儿体外循环 (CPB)中进行超滤的临床经验。方法 1999年至2 0 0 2年 ,共进行 10kg以下小儿CHD心内直视手术 14 94例 ,其中复杂畸形 6 2 5例 ,所有病例都在手术中使用超滤。超滤方法包括常规超滤 (CUF)、改良超滤 (MUF)、平衡超滤 (BUF)以及联合应用等形式。部分病例测量转流前 ,转流结束和MUF结束时肿瘤坏死因子 (TNF) ,白介素 - 8(IL - 8)和E -选择素 (E -selectin)浓度。结果 14 94例患儿中未发现同超滤有关的并发症。采用CUF 2 1例 ,MUF 811例 ,BUF 2 0例 ,常规结合MUF 5 89例 ,BUF +MUF 5 3例。三种超滤方法时间分别为 (11.4 9± 6 .6 1)min ,(11.35± 2 .5 8)min和 (46 .0 4± 2 2 .4 1)min ,分别滤出液体 (135 .75± 4 0 .5 6 )ml,(332 .6 6± 112 .99)ml和 (5 2 7.2 7± 35 3.6 5 )ml。全组患者术中红细胞比积 (Hct)(0 .2 4 6± 0 .0 2 6 )L/L ,CUF结束时Hct(0 .2 6 1± 0 .0 2 5 )L/L ,MUF结束Hct为 (0 .339± 0 .0 34)L/L。TNF ,IL - 8和E -选择素测量结果显示 ,BUF能降低转流过程中炎症因子上升的幅度 ,MUF在浓缩血液的同时也增加了炎症因子的浓度。结论 超滤能够滤出炎性介质等有害物质。BUF法依靠置换作用可降低炎性介质的浓度。CUF和MUF都可浓缩血?

OBJECTIVE The objective of this study is to summarize the clinical usage of ultrafiltration in pediatric cardiopulmonary bypass (CPB). METHODS 1494 cases with congenital heart disease less than 10 kg, including 625 complex malformation, were operated from 1999 to 2002. Three ultrafiltration methods, conventional ultrafiltration (CUF), modified ultrafiltration (MUF) and balanced ultrafiltration (BUF), were used alone or combined routinely. RESULTS No complications relative to ultrafiltrationwas was found . CUF was used in 21 cases, MUF 811cases, BUF 20 cases, CUF with MUF 589 cases and BUF with MUF 53 cases. The durations of CUF, MUF and BUF were (11.49±6.61)minuts, (11.35±2.58)minuts and (46.04±22.41)minutes respectively. And the ultrafiltrated volumes were (135.75±40.56)ml, (332.66±112.99)ml and (527.27±353.65)ml respectively. The hematocrits in CPB were (0.246±0.026)L/L after CUF it changed to( 0.261±0.025)L/L and after MUF (0.340±0.034)L/L. BUF decreases the concentrations of inflammatory mediates, whereas MUF increases their concentrations. CONCLUSION Inflammatory mediates can be removed by ultrafiltration. Both CUF and MUF can concentrate the blood, but MUF is more efficient than CUF. MUF also can filtered out the superfluous water and improve organs' function. In addition, ultrafiltration may have the effect of inhibiting the allergic reaction caused by protamine.